Medication and physician prescribing practices have a significant impact on the course of asthma. Several studies have documented that the major factors contributing to asthma morbidity are under-diagnosis and inappropriate treatment (1995 NHLBI/WHO Workshop Report). The objectives of this application are to study the relationship between asthma control and medication utilization. This application proposes to extend a retrospective analysis of the Tennessee Medicaid population to determine risk factors for asthma exacerbations requiring hospital care, to characterize medication utilization patterns that predict such events, and to develop a management scheme based on identification of medication use through a pharmacy-based drug utilization program. We hypothesize that there are timely predictors of asthma exacerbations requiring hospital care in high-risk populations, and that these predictors should be utilized in clinical practice to both identify those at risk and initiate appropriate clinical management. To test this hypothesis we will use an existing retrospective database to determine patterns of beta-agonist use and prescribing that predict asthma exacerbations requiring hospital care or corticosteroid rescue. We will then test whether these usage patterns predict asthma exacerbations using prospective data, and test a beta-agonist utilization management strategy in clinical practice. The ultimate goal of these analyses will be to (1) develop a computerized pharmacy-based drug utilization review program to identify, in a timely manner, those patients at a high risk of an asthma exacerbation, as well as physicians with high-risk patients and inadequate prescribing practices, and (2) develop a step-wise approach of asthma management based on an objective drug utilization strategy. In specific aim #1 we propose to define medication utilization patterns that predict asthma exacerbations requiring hospital care or systemic corticosteroid rescue. We hypothesize that beta-agonist utilization is a predictor of such asthma exacerbations. To test this hypothesis we will utilize the Tennesse Medicaid Database. In specific Aim #2 we will perform a prospective case-crossover study of medication utilization in asthma patients requiring hospitalization. We hypothesize that for high risk asthmatics requiring hospital care, quantification of beta-agonist use, rather than the standard measures of using peak expiratory flows or symptom reporting, is a better means of predicting disease exacerbation. In specific aim #3 we propose to develop a management strategy in high risk asthma patients using medication utilization patients via a computerized pharmacy identification system and a stepwise management modality based on beta-agonist use.